Showing posts with label Mobilization. Show all posts
Showing posts with label Mobilization. Show all posts
Tuesday, December 16, 2008

New Study Shows Manual Physical Therapy and Exercise ProducesSignificant Improvements in Neck Pain

ALEXANDRIA, VA, December 12, 2008 — The American Physical Therapy Association (APTA) is urging patients with musculoskeletal pain to consider treatment by a physical therapist, in light of a new federal survey showing that more than one-third of American adults and nearly 12 percent of children use alternative medicine - with back and neck pain being the top reasons for treatment. Results of the 2007 survey of more than 32,000 Americans were released December 11 by the National Institutes of Health's National Center for Complementary and Alternative Medicine.

According to APTA, physical therapy offers an evidence-based, time-tested solution to these common conditions in comparison to alternative treatments.
For neck pain, for example, a recent study published in the medical journal Spine found that when patients received up to six treatments of manual physical therapy and exercise, they not only experienced pain relief, but were also less likely to seek additional medical care up to one year following treatment.

"This study, demonstrating the efficacy of physical therapy for a condition as widespread as neck pain, is particularly relevant in today's challenging economic environment," according to the study's lead researcher and APTA spokesman Michael Walker, PT, DSc, OCS, CSCS, FAAOMPT. "The Kaiser Foundation, for instance, recently found that more than half of all Americans are not taking prescribed medication and postponing needed medical care in an effort to save money. It is important for consumers to know that there are effective, conservative solutions such as physical therapy available.1"

Walker's study compared the effectiveness of a three-week program of manual physical therapy and exercise to a minimal intervention treatment approach for patients with neck pain.
Study participants consisted of 94 patients with a primary complaint of neck pain, 58 (62%) of whom also had radiating arm pain. Patients randomized to the manual physical therapy and exercise group received joint and soft-tissue mobilizations and manipulations to restore motion and decrease pain, followed by a standard home exercise program of chin tucks, neck strengthening, and range-of-motion exercises. Patients in the minimal intervention group received treatment consistent with the current guidelines of advice, range-of-motion exercise, and any medication use prescribed by their general practitioner. Patients did not have to complete all six visits if their symptoms were fully resolved.
Sample exercises to relieve neck pain can be found on the APTA Web site, www.apta.org/consumer.

Results show that manual physical therapy and exercise was significantly more effective in reducing mechanical neck pain and disability and increasing patient-perceived improvements during short- and long-term follow-ups. These results are comparable with previous studies that found manual physical therapy and exercise provided greater treatment effectiveness (Hoving et al, 2002)2 and cost effectiveness (Kothals-de Bos et al, 2003)3 than general practitioner care.
"Physical therapist intervention can be an effective, high-value, conservative solution for treatment of musculoskeletal pain," said Walker.

"Physical therapists can help individuals improve mobility and quality of life without expensive surgery or the side effects of pain medication. We give patients the tools they need, such as the home program we used in the study, to help them prevent or manage a condition in order to achieve long-term health benefits."

Physical therapists are highly-educated, licensed health care professionals who can help patients reduce pain and improve or restore mobility — without expensive surgery or the side effects of medications. APTA represents more than 70,000 physical therapists, physical therapist assistants, and students of physical therapy nationwide. Its purpose is to improve the health and quality of life of individuals through the advancement of physical therapist practice. Learn more about conditions physical therapists can treat at www.apta.org/consumer, and find a physical therapist in your area at www.findapt.us.


1 http://www.kff.org/kaiserpolls/h08_posr102108pkg.cfm
2 Hoving JL, Koes BW, de Vet HC, van der Windt DA, et al. Manual Therapy, Physical Therapy, Or Continued Care by a General Practitioner for Patients with Neck Pain. Ann Intern Med 2002;136 (10):713-722
3 Korthals-de Bos IB, Hoving JL, van Tulder MW, et al. Cost effectiveness of physiotherapy, manual therapy, and general practitioner care for neck pain: economic evaluation alongside a randomised controlled trial. BMJ 2003;326 (7395):911

Tuesday, October 21, 2008



Tallahassee, Florida, October 20, 2008 – Neck pain is one of the top 10 reasons for a patient to visit a doctor. The lead article in the most recent issue Spine reports on the results of a randomized clinical trial which demonstrated that patients who received manual physical therapy and exercise had twice the improvement in symptoms compared to the current guideline group. The subjects in the study experienced both short and long term improvements in their neck pain. The study compared the use of manual therapy and exercise compared to the current guidelines of advice, rest, and range of motion. The results of this study are comparable to those reported by Hoving et al in 2002, which also demonstrated that manual physical therapy and exercise resulted in excellent clinical results in the treatment of neck pain while also providing a significant cost savings compared to usual physician care (Kothals-de Bos et al 2003). Manual physical therapy includes the use of hands-on techniques including joint and soft-tissue mobilization, designed to restore motion and reduce pain. Hurwitz et al (2008) concluded in a systematic review on neck pain also in the journal Spine, “Our best evidence synthesis suggests that therapies involving manual therapy and exercise are more effective than alternative strategies for patients with neck pain.”

Tim Flynn, PT, PhD, president of the American Academy of Orthopaedic Manual Physical Therapy, expressed confidence that, “This study broadens the base and depth of evidence that manual physical therapy is the first line treatment for patients suffering from neck and arm pain.” He continued, “Year after year the physical therapy profession continues to produce high quality randomized, controlled trials that demonstrate conclusively that our profession provides better outcomes for less money, while also being substantially safer than other medical interventions. Wake up America, to a new day without pain.” If you have neck or back pain or the aches and pains of musculoskeletal problems contact your local physical therapist today.

Jason L. Harris

0 comments Friday, September 28, 2007


Students from the University of Regis attempt to spread the knowledge regarding the Clinical Prediction Rule for SI manipulation. Fairly corny, but it gets the point across. Appears aimed at the clinician more than a prospective patient.

Are you manipulating your patients that fit the CPR? Change is difficult, but must be made to continue evolving as clinicians and providing the best care known (friggin state of Iowa and their collusion with "Palmerville")



0 comments Tuesday, September 25, 2007


I just finished reading a guest editorial by Robert Wainner, PT, PhD and Julie Whitman, PT, DSc regarding first line interventions for hip pain in the most recent Journal of Orthopaedic & Sports Physical Therapy. Their discussion points to the trend that hip pain, especially OA, is treated in the order of 1. Drugs, 2. Surgery/invasive procedure, 3. Physical Therapy.

Why is PT last? Especially when there are known PT interventions for hip pain that work well. The authors point our that research on exercise for hip pain is not as broad as the knee; but some recent hight quality studies (which include those published by the authors) lend us the ability to form a practice guideline as to treat hip pain. This includes manual physical therapy (mobilization/manipulation) and exercise as the primary exercises.

The general public reading this should also demand (yes, demand, lol) from their primary care doctors that PT is the first line intervention for their hip pain. On our end, we (as PT's) must stay abreast the on current best evidence for treating hip pain - again, mobs and exercise as primary treatment - and APPLY this treatment. We must change and adapt as clinicians.

If you have questions about your hip pain, please as your doctor to refer you to a PT, use the APTA's "Find a PT" tool, or I can try to answer any comments you leave.

0 comments Tuesday, July 3, 2007

Here is a good free video posted on YouTube on how to perform the Mulligan fibular glide for inversion ankle sprains.



Kym Moiler et al published a pilot study on this taping technique in the Journal of Orthopaedic & Sports Physical Therapy in September of 2006.

In 1999 Kavanagh published a study in Manual Therapy on the link between distal tibiofibular positional faults and inversion sprains.

Professionally, I like to perform gentle (Grade 1-3) Anterior to Posterior and superior fibular mobilization on acute and chronically painful ankle sprains to relieve pain and increase ROM. Especially dorsiflexion. I've had good success; but, that is my personal experience only.

This taping technique is a nice tool to help emphasize the benefits from the manual mobilizations.